Relationship of Peptic Ulceration to Gastric Chemism

Abstract

The relationship of gastric acidity to peptic ulceration has been debated for years. The present investigation was undertaken in an attempt to evaluate the etiologic importance of gastric acidity. A total of 125 dogs was used, but of this number 68 died at various intervals after the operation, leaving 57 animals on which our results are based. Each animal was kept in separate clean quarters with a constant supply of fresh drip water. They were allowed to play on the roof on sunshiny days. All the lesions described were submitted to microscopic study. Gastric analysis was done about 6 times before operation and then once a week postoperatively after a standard test meal of cracker dust. The following series of dogs were used as controls or received thrice daily every other day either 1% HCl feeding or 1/25 to 8/10 mg. histamine injections subcutaneously: I. No operative procedures were done to get the gastric reaction to the HQ feeding or histamine injections. II. Extirpation of (a) greater curvature; (b) lesser curvature. III. Formation of a gastric pouch from (a) greater curvature of Heidenhain type, or (b) lesser curvature (Pavlov type) plus anastomosis of the proximal jejunum to the pouch. IV. Same as series III plus anastomosis of fundus of gall bladder to the pouch.

Repeated HCl feeding produced multiple acute lesions—-petechiae, erosions and shallow ulcers of the stomach and duodenum, which were observed as early as 5 days after starting the feedings. In the longer experiments (2 months), there was associated a mild to marked gastritis and duodenitis with increased mucus production. In general there was a tendency toward temporary achlorhydria with a return to normal values of free HCl after a month or so of experimentation. Histamine injections also gave similar results.